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Inwald CE, Gerken M, Pauer A, Klinkhammer-Schalke M, Ortmann O. Einfluss der COVID-19-Pandemie auf die Inzidenz, Stadienverteilung und Therapien von Krebserkrankungen. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1749054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- C E Inwald
- Klinik für Frauenheilkunde und Geburtshilfe, Klinik St. Caritas, Universitätsklinikum, Regensburg
| | - M Gerken
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
| | - A Pauer
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
| | - M Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
| | - O Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe, Klinik St. Caritas, Universitätsklinikum, Regensburg
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Filippini Velázquez G, Schiele S, Gerken M, Neumaier S, Hackl C, Mayr P, Klinkhammer-Schalke M, Illerhaus G, Schlitt HJ, Anthuber M, Kröncke T, Messmann H, Märkl B, Schmid C, Trepel M, Müller G, Claus R, Hackanson B. Predictive preoperative clinical score for patients with liver-only oligometastatic colorectal cancer. ESMO Open 2022; 7:100470. [PMID: 35461024 PMCID: PMC9271475 DOI: 10.1016/j.esmoop.2022.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Resection of liver metastases from colorectal cancer (CRC) in the oligometastatic stage improves survival and is a potentially curative treatment. Thus, predictive scores that reliably identify those patients who especially benefit from surgery are essential. Patients and methods In this multicenter analysis, 512 patients had undergone surgery for liver metastases from CRC. We investigated distinct cancer-specific risk factors that are routinely available in clinical practice and developed a predictive preoperative score using a training cohort (TC), which was thereafter tested in a validation cohort (VC). Results Inflammatory response to the tumor, a right-sided primary tumor, multiple liver metastases, and node-positive primary tumor were significant adverse variables for overall survival (OS). Patients were stratified in five groups according to the cumulative score given by the presence of these risk factors. Median OS for patients without risk factors was 133.8 months [95% confidence interval (CI) 81.2-not reached (nr)] in the TC and was not reached in the VC. OS decreased significantly for each subsequent group with increasing number of risk factors. Median OS was significantly shorter (P < 0.0001) for patients presenting all four risk factors: 14.3 months (95% CI 10.5 months-nr) in the TC and 16.6 months (95% CI 14.6 months-nr) in the VC. Conclusions Including easily obtainable variables, this preoperative score identifies oligometastatic CRC patients with prolonged survival rates that may be cured, and harbors potential to be implemented in daily clinical practice. We identified four variables of adverse outcome for patients treated with surgical resection of liver metastases from CRC. Adverse variables were inflammatory response to the tumor, multiple metastases, right-sided primary tumor, node-positive primary tumor. We developed a preoperative clinical score according to the number of risk factors present. Using easily obtainable variables, this score identified patients with oligometastatic CRC with good prognosis. Patients without risk factors should strongly be considered for surgical resection of their metastases.
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Affiliation(s)
- G Filippini Velázquez
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - S Schiele
- Faculty of Applied Mathematics and Statistics, University of Augsburg, Augsburg, Germany
| | - M Gerken
- Tumor Center Regensburg, Institute for Quality Assurance and Health Service Research, University of Regensburg, Regensburg, Germany
| | - S Neumaier
- Department of Haematology and Oncology, Katharinen Hospital Stuttgart, Stuttgart, Germany
| | - C Hackl
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - P Mayr
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - M Klinkhammer-Schalke
- Tumor Center Regensburg, Institute for Quality Assurance and Health Service Research, University of Regensburg, Regensburg, Germany
| | - G Illerhaus
- Department of Haematology and Oncology, Katharinen Hospital Stuttgart, Stuttgart, Germany
| | - H J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - M Anthuber
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - T Kröncke
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - H Messmann
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - B Märkl
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - C Schmid
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - M Trepel
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - G Müller
- Faculty of Applied Mathematics and Statistics, University of Augsburg, Augsburg, Germany
| | - R Claus
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany; General Pathology and Molecular Diagnostics, Faculty of Medicine, University of Augsburg, Augsburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - B Hackanson
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Fernandez-Pacheco M, Inwald EC, Gerken M, Ignatov A, Klinkhammer-Schalke M, Ortmann O. Impact of Marging Shaving on Re-Excision rates in patients with primary invasive carcinoma and carcinoma in situ in Breast Conserving Surgery. Data from a population based cohort of clinical cancer registry. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Fernandez-Pacheco
- University Medical Center Regensburg, Department of Gynaecology and Obstetrics
| | - EC Inwald
- University Medical Center Regensburg, Department of Gynaecology and Obstetrics
| | - M Gerken
- University of Regensburg, Tumor Center Institute for Quality Management and Health Services Research
| | - A Ignatov
- University Medical Center Regensburg, Department of Gynaecology and Obstetrics
| | - M Klinkhammer-Schalke
- University of Regensburg, Tumor Center Institute for Quality Management and Health Services Research
| | - O Ortmann
- University Medical Center Regensburg, Department of Gynaecology and Obstetrics
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Hetterich M, Gerken M, Ortmann O, Klinkhammer-Schalke M, Ignatov A. Micrometastases in axillary lymph nodes and outcome of breast cancer. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Hetterich
- Universitätsfrauenklinik Regensburg, Caritas St. Josef Krankenhaus, Gynäkologie und Geburtshilfe
| | - M Gerken
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität
| | - O Ortmann
- Universitätsfrauenklinik Regensburg, Caritas St. Josef Krankenhaus, Gynäkologie und Geburtshilfe
| | - M Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität
| | - A Ignatov
- Universitätsfrauenklinik Regensburg, Caritas St. Josef Krankenhaus, Gynäkologie und Geburtshilfe
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Inwald EC, Klinkhammer-Schalke M, Gerken M, Pauer A, Ortmann O. Implementierung der leitliniengerechten Therapie bei Patientinnen mit frühem HER2-positiven Mammakarzinom in der klinischen Routine (2006–2018) – Daten einer bevölkerungsbezogenen Kohorte eines Klinischen Krebsregisters. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
- EC Inwald
- Universität Regensburg, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | - M Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg
| | - M Gerken
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg
| | - A Pauer
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg
| | - O Ortmann
- Universität Regensburg, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
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Fernandez-Pacheco M, Ortmann O, Gerken M, Ignatov A, Klinkhammer-Schalke M, Inwald EC. Impact of Marging Shaving on Re-Excision rates in patients with primary invasive carcinoma and carcinoma in situ in Breast Conserving Surgery. Data from a population based cohort of clinical cancer registry. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
| | - O Ortmann
- University Medical Center Regensburg
| | - M Gerken
- Tumor Center Institute for Quality Management and Health Services Research, University of Regensburg
| | - A Ignatov
- University Medical Center Regensburg
| | - M Klinkhammer-Schalke
- Tumor Center Institute for Quality Management and Health Services Research, University of Regensburg
| | - EC Inwald
- University Medical Center Regensburg
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Inwald EC, Klinkhammer-Schalke M, Gerken M, Pauer A, Ortmann O. Implementierung der leitliniengerechten Therapie bei Patientinnen mit frühem HER2-positiven Mammakarzinom in der klinischen Routine (2006 – 2018) – Daten einer bevölkerungsbezogenen Kohorte eines Klinischen Krebsregisters. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- E C Inwald
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Universität Regensburg
| | - M Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg
| | - M Gerken
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg
| | - A Pauer
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg
| | - O Ortmann
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Universität Regensburg
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Inwald EC, Klinkhammer-Schalke M, Koller M, Zeman F, Hofstädter F, Evert M, Brockhoff G, Ortmann O. Höheres Alter ist ein Prädiktor für die Unterversorgung von Patientinnen mit primärem Mammakarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- EC Inwald
- Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Regensburg, Deutschland
| | - M Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Deutschland
| | - M Koller
- Zentrum für Klinische Studien, Universität Regensburg, Regensburg, Deutschland
| | - F Zeman
- Zentrum für Klinische Studien, Universität Regensburg, Regensburg, Deutschland
| | - F Hofstädter
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Deutschland
| | - M Evert
- Institut für Pathologie, Universität Regensburg, Regensburg, Deutschland
| | - G Brockhoff
- Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Regensburg, Deutschland
| | - O Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Regensburg, Deutschland
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Inwald EC, Klinkhammer-Schalke M, Koller M, Zeman F, Ortmann O. Höheres Alter ist ein Prädiktor für die Unterversorgung von Patientinnen mit primärem Mammakarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1655519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- EC Inwald
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Universität Regensburg
| | - M Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg
| | - M Koller
- Zentrum für Klinische Studien, Universität Regensburg
| | - F Zeman
- Zentrum für Klinische Studien, Universität Regensburg
| | - O Ortmann
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Universität Regensburg
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Kirzinger L, Schneider R, Mayer C, Schötz S, Backhaus R, Gerken M, Klinkhammer-Schalke M, Schalke B. The influence of thymoma- surgery on paraneoplastic myasthenia gravis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Papathemelis T, Scharl S, Kronberger K, Gerken M, Scharl A, Pauer A, Klinkhammer-Schalke M. Survival benefit of pelvic and paraaortic lymphadenectomy in high-grade endometrial carcinoma: a retrospective population-based cohort analysis. J Cancer Res Clin Oncol 2017; 143:2555-2562. [PMID: 28840384 DOI: 10.1007/s00432-017-2508-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/17/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The standard therapy for high-grade endometrial cancer is surgery but the therapeutic effects of pelvic and paraaortic lymph node dissection (LND) are poorly investigated. In this study, we retrospectively evaluated overall survival, recurrence rates and recurrence-free survival among patients with high-grade type I and II endometrial carcinoma who underwent LND. METHODS This study included 284 patients who are recorded in the German Tumor Centre Regensburg form 1998 to 2015 and were selected by cancer grading, the absence of secondary tumors, primary surgery including hysterectomy and available follow-up. 244 of the 284 patients in this cohort were unequivocally classified as R0 after resection. RESULTS A significantly increased overall survival was observed for systematic LND of 25 or more paraaortic and pelvic lymph nodes versus patients who did not undergo such intervention (p < 0.001) or had elective LND of 1-24 lymph nodes both in univariable (p = 0.016) and multivariable (p = 0.014) analysis. A similar observation was made for recurrence-free survival of patients in the cohort who underwent complete tumor resection (R0). In addition, a reduced cumulative recurrence rate was observed for patients with systematic LND. CONCLUSIONS Our study provides evidence that the systematic removal of 25 or more pelvic and paraaortic lymph nodes reduces the recurrence rate and that it is beneficial for the long-term overall and recurrence-free survival of patients with high-grade endometrial cancer.
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Affiliation(s)
| | - S Scharl
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93051, Regensburg, Germany
| | - K Kronberger
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - M Gerken
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - A Scharl
- Frauenklinik, Klinikum St. Marien Amberg, Amberg, Germany
| | - A Pauer
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - M Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am Biopark 9, 93053, Regensburg, Germany
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Inwald EC, Klinkhammer-Schalke M, Koller M, Zeman F, Ortmann O. Die screening-relevante Altersgrenze von ≥70 Jahren ist entscheidender für die Durchführung einer adjuvanten Therapie als die Tumorbiologie bei Patientinnen mit Mammakarzinom. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1602353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- EC Inwald
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Universität Regensburg
| | - M Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg
| | - M Koller
- Zentrum für Klinische Studien, Universität Regensburg
| | - F Zeman
- Zentrum für Klinische Studien, Universität Regensburg
| | - O Ortmann
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Universität Regensburg
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Inwald EC, Koller M, Klinkhammer-Schalke M, Zeman F, Hofstädter F, Gerstenhauer M, Brockhoff G, Ortmann O. Gelingt die tumorbiologische Subtypisierung bei Patientinnen mit Mammakarzinom in der klinischen Routine? – Ergebnisse einer großen Kohorte eines klinischen Krebsregisters. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Inwald EC, Koller M, Klinkhammer-Schalke M, Zeman F, Hofstädter F, Gerstenhauer M, Brockhoff G, Ortmann O. Gelingt die tumorbiologische Subtypisierung bei Patientinnen mit Mammakarzinom in der klinischen Routine? – Ergebnisse einer großen Kohorte eines klinischen Krebsregisters. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1580673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Inwald EC, Koller M, Klinkhammer-Schalke M, Zeman F, Hofstädter F, Gerstenhauer M, Ortmann O. Brustkrebssubtypen und Überleben – Analyse von Daten aus einem klinischen Krebsregister. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0035-1570048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Klinkhammer-Schalke M, Gerken M, Barlag H, Teufel A. Nutzung von Krebsregisterdaten zur Messung der Qualität in der klinischen Onkologie und für Versorgungsforschung. Onkologe 2016. [DOI: 10.1007/s00761-015-2940-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Inwald E, Koller M, Klinkhammer-Schalke M, Zeman F, Hofstädter F, Lindberg P, Gerstenhauer M, Seitz S, Seiz L, Ortmann O. Adjuvante endokrine Therapie bei Patientinnen mit Hormonrezeptor-positivem Mammakarzinom – Ergebnisse einer großen bevölkerungsbezogenen Kohorte eines klinischen Krebsregisters. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1555089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Inwald E, Klinkhammer-Schalke M, Koller M, Ortmann O. Quality Assurance for Patients with Breast Cancer – the Impact of Clinical Cancer Registries. Geburtshilfe Frauenheilkd 2014; 74:868-874. [DOI: 10.1055/s-0034-1383052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- E. Inwald
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg
| | | | - M. Koller
- University Hospital Regensburg, Center for Clinical Studies, Regensburg
| | - O. Ortmann
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg
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Inwald EC, Ortmann O, Zeman F, Koller M, Hofstädter F, Gerstenhauer M, Klinkhammer-Schalke M. Eine leitliniengerechte Therapie verbessert das Gesamtüberleben von HER2-positiven Mammakarzinom-Patientinnen – Daten einer bevölkerungsbezogenen Kohorte eines Klinischen Krebsregisters. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Klinkhammer-Schalke M, Lindberg P, Koller M, Steinger B, Ortmann O, Hofstädter A, Scharl A, Inwald E, Lorenz W. Patientenwohl. Lebensqualität bei Brustkrebs-Patientinnen – Implementierung und Umsetzung in die Routineversorgung. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1368626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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McCool M, Apfelbacher C, Loss J, Hartmann M, Klinkhammer-Schalke M, Gerken M. Versorgungsforschung im Bereich Darmkrebs: Analyse der Behandlungsströme von Patienten mit kolorektalen Lebermetastasen. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ried M, Speth U, Potzger T, Neu R, Diez C, Klinkhammer-Schalke M, Hofmann HS. [Regional treatment of malignant pleural mesothelioma: results from the tumor centre Regensburg]. Chirurg 2013; 84:987-93. [PMID: 23743993 DOI: 10.1007/s00104-013-2518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Malignant pleural mesothelioma (MPM) is an aggressive, malignant tumor of the pleural surface and is strongly associated with asbestos exposure. Incidence of MPM will reach its peak over the coming years. Most patients present with advanced tumor stages and therefore surgical options are limited. PATIENTS AND METHODS Retrospective analysis of all patients with MPM reported to the tumor centre Regensburg between January 1998 and August 2011. RESULTS A total of 118 patients (85 % male) with cytologically or histologically confirmed MPM were reported. The mean age at diagnosis was 67 years (range 45-84 years) and 65 % of patients had a history of asbestos exposure. The incidence of MPM at the tumor centre Regensburg was 0.8/100,000 inhabitants with obvious regional differences depending on asbestos exposure. Staging was completed in 81 patients (67 %): stage I 9 %, stage II 22 %, stage III 23 % and stage IV 46 %. Of the patients 87 (74 %) underwent at least one surgical procedure: diagnostic thoracoscopy with biopsy (n = 37, 43 %), debulking surgery or talcum pleurodesis (n = 33, 38 %) and potentially curative resection (n = 17, 19 %). After a mean follow-up of 20 months the overall median survival was 14 months (1 year survival rate 62 %, 3 year survival rate 15 %). Patients had a significantly better median survival of 18 months after curative resection. CONCLUSIONS The distribution of MPM varies according to regional and industrial asbestos exposure. Screening and diagnostics should concentrate on locations with higher incidence of MPM to facilitate surgical therapy in a multimodal treatment regime.
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Affiliation(s)
- M Ried
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland,
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Inwald EC, Klinkhammer-Schalke M, Hofstädter F, Zeman F, Koller M, Gerstenhauer M, Ortmann O. Ki-67 is a prognostic parameter in breast cancer patients: results of a large population-based cohort of a cancer registry. Breast Cancer Res Treat 2013; 139:539-52. [PMID: 23674192 PMCID: PMC3669503 DOI: 10.1007/s10549-013-2560-8] [Citation(s) in RCA: 368] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 04/30/2013] [Indexed: 12/12/2022]
Abstract
The proliferation marker Ki-67 is one of the most controversially discussed parameters for treatment decisions in breast cancer patients. The purpose of this study was to evaluate the routine use and value of Ki-67 as a prognostic marker, and to analyze the associations between Ki-67 and common histopathological parameters in the routine clinical setting. Data from the clinical cancer registry Regensburg (Bavaria, Germany) were analyzed. Within the total data pool of 4,692 female patients, who had been diagnosed between 2005 and 2011, in 3,658 cases Ki-67 was routinely determined. Thus, a total of 3,658 patients with invasive breast cancer were included in the present study and used for statistical analysis. Ki-67 expression was associated with the common histopathological parameters. The strongest correlation was found between grading and Ki-67 (P < 0.001). In terms of survival analyses, Ki-67 was categorized into five categories (reference category Ki-67 ≤15 %) due to a nonlinear relationship to overall survival (OS). In multivariable analysis, Ki-67 was an independent prognostic parameter both for disease-free survival (DFS) (Ki-67 > 45 %, HR = 1.96, P = 0.001) as well as for OS (Ki-67: 26-35 %, HR = 1.71, P = 0.017; Ki-67: 36-45 %, HR = 2.05, P = 0.011; Ki-67 > 45 %, HR = 2.06, P = 0.002) independent of common clinical and histopathological factors. The 5-year DFS (OS) rate was 86.7 % (89.3 %) in patients with a Ki-67 value ≤15 % compared to 75.8 % (82.8 %) in patients with a Ki-67 value >45 %. Based on the data from a large cohort of a clinical cancer registry, it was demonstrated that Ki-67 is frequently determined in routine clinical work. Ki-67 expression is associated with common histopathological parameters, but is an additional independent prognostic parameter for DFS and OS in breast cancer patients. Future work should focus on standardization of Ki-67 assessment and specification of its role in treatment decisions.
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Affiliation(s)
- E C Inwald
- Department of Gynecology and Obstetrics, University of Regensburg, Caritas Krankenhaus St. Josef Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany.
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Klinkhammer-Schalke M, Tillack AV, Gerken M, Jagota A, Engel J, Klug S. Daten klinischer Krebsregister für Versorgungsforschung. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lindberg P, Lorenz W, Steinger B, Wyatt J, Hofstädter F, Klinkhammer-Schalke M. Considerable differences in the evaluation of global quality of life in primary breast cancer patients – Results in the control group of a randomized controlled trial. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Inwald EC, Klinkhammer-Schalke M, Hofstädter F, Gerken M, Gerstenhauer M, Ortmann O. Darstellung der Ergebnisqualität der Routineversorgung von Frauen mit primärem Mammakarzinom - Daten aus dem klinischen Krebsregister des Tumorzentrums Regensburg. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1318526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Klinkhammer-Schalke M, Koller M, Steinger B, Ehret C, Ernst B, Wyatt JC, Hofstädter F, Lorenz W. Direct improvement of quality of life using a tailored quality of life diagnosis and therapy pathway: randomised trial in 200 women with breast cancer. Br J Cancer 2012; 106:826-38. [PMID: 22315052 PMCID: PMC3305975 DOI: 10.1038/bjc.2012.4] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 01/03/2012] [Accepted: 01/06/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite thousands of papers, the value of quality of life (QoL) in curing disease remains uncertain. Until now, we lacked tools for the diagnosis and specific treatment of diseased QoL. We approached this problem stepwise by theory building, modelling, an exploratory trial and now a definitive randomised controlled trial (RCT) in breast cancer, whose results we report here. METHODS In all, 200 representative Bavarian primary breast cancer patients were recruited by five hospitals and treated by 146 care professionals. Patients were randomised to either (1) a novel care pathway including diagnosis of 'diseased' QoL (any QoL measure below 50 points) using a QoL profile and expert report sent to the patient's coordinating practitioner, who arranged QoL therapy consisting of up to five standardised treatments for specific QoL defects or (2) standard postoperative care adhering to the German national guideline for breast cancer. The primary end point was the proportion of patients in each group with diseased QoL 6 months after surgery. Patients were blinded to their allocated group. RESULTS At 0 and 3 months after surgery, diseased QoL was diagnosed in 70% of patients. The QoL pathway reduced rates of diseased QoL to 56% at 6 months, especially in emotion and coping, compared with 71% in controls (P=0.048). Relative risk reduction was 21% (95% confidence interval (CI): 0-37), absolute risk reduction 15% (95% CI: 0.3-29), number needed to treat (NNT)=7 (95% CI: 3-37). When QoL therapy finished after successful treatment, diseased QoL often returned again, indicating good responsiveness of the QoL pathway. CONCLUSION A three-component outcome system including clinician-derived objective, patient-reported subjective end points and qualitative analysis of clinical relevance was developed in the last 10 years for cancer as a complex intervention. A separate QoL pathway was implemented for the diagnosis and treatment of diseased QoL and its effectiveness tested in a community-based, pragmatic, definitive RCT. While the pathway was active, it was effective with an NNT of 7.
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Pfaff H, Abholz H, Glaeske G, Icks A, Klinkhammer-Schalke M, Nellessen-Martens G, Neugebauer E, Ohmann C, Schrappe M, Selbmann HK, Stemmer R. Versorgungsforschung: unverzichtbar bei Allokationsentscheidungen – eine Stellungnahme. Dtsch Med Wochenschr 2011; 136:2496-500. [DOI: 10.1055/s-0031-1272579] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Klotz T, Mathers MJ, Gerken M, Klinkhammer-Schalke M, Hofstädter F. [Social gradient of PSA screening? 8 years follow up from the cancer registry of the tumor center in Regensburg]. Urologe A 2011; 49:1503-7. [PMID: 20945060 DOI: 10.1007/s00120-010-2425-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prostate cancer is the most frequent male cancer. In Germany most tumors are detected by PSA testing. Data on the long-term survival of patients with localized early prostate carcinoma are insufficient. We examined the relative survival of the patients with organ-defined prostate cancer (TNM T1-2N0M0, UICC I-II) compared to the standardized age-adjusted rates of the normal male population. METHODS Epidemiological and clinical data from 4,124 patients with prostate cancer diagnosed from 1998 to 2007 were extracted from the cancer registry of the tumor center in Regensburg; 2,087 patients suffered from localized early cancer. Kaplan-Meier analysis was used to estimate the overall survival rates in the patient cohorts irrespective of primary cancer therapy. These rates were adjusted for the expected survival rates in a comparable set of individuals from the general population. RESULTS Eight years after diagnosis, patients with stage I and II localized prostate cancer had an approximately 10% relative increase in survival compared with the normal male population. This relative increase in survival was already observed 3 years after diagnosis. CONCLUSION Patients with stage I-II localized prostate cancer have improved survival compared with the normal male population. This finding cannot be explained solely by the administration of prostate cancer treatments, which do not affect survival until 8-10 years after treatment, suggesting that men who participate in PSA testing may have a better overall health status. Another hypothesis may be a social gradient of PSA testing in Germany.
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Affiliation(s)
- T Klotz
- Klinik für Urologie, Andrologie und Kinderurologie, Kliniken Nordoberpfalz AG, Söllnerstraße 16, 92637, Weiden, Deutschland.
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Mathers MJ, Roth S, Gerken M, Klinkhammer-Schalke M, Hofstädter F, Heidenreich A, Klotz T. Evaluation of the state of health of patients with localized prostate cancer (cT1-cT2) compared to the normal population. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Schimanski S, Wild PJ, Treeck O, Horn F, Sigruener A, Rudolph C, Blaszyk H, Klinkhammer-Schalke M, Ortmann O, Hartmann A, Schmitz G. Expression of the lipid transporters ABCA3 and ABCA1 is diminished in human breast cancer tissue. Horm Metab Res 2010; 42:102-9. [PMID: 19902402 DOI: 10.1055/s-0029-1241859] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ATP-binding cassette transporters ABCA3 and ABCA1 are related to a differentiated, lipid-secreting phenotype of type II pneumocytes. Since mammary gland epithelial cells also show pronounced lipid metabolism and secretion, we investigated the expression of these proteins in normal as well as in neoplastic breast tissue. Normal human breast tissue, breast cancer cell lines, and 162 tumor samples of patients with primary unilateral invasive breast cancer were analyzed for ABCA3 and ABCA1 protein expression by immunohistochemistry using tissue microarrays. Strong ABCA3 and ABCA1 expression was found in the inner layer of normal mammary gland epithelium. Concurrent cytoplasmic ABCA3 and ABCA1 immunoreactivity was found in 9 of 11 breast cancer cell lines. ABCA3 and ABCA1 were shown to be differentially expressed in human breast cancer. Loss of ABCA3 staining was significantly associated with positive nodal status and negative progesterone receptor expression. In multivariate analysis, diminished ABCA3 expression proved to be a significant, independent and adverse risk factor for tumor recurrence. ABCA1 expression was associated with positive lymph nodes, but not significantly associated with tumor recurrence or breast cancer-specific survival. ABCA3 and ABCA1 are strongly expressed in normal mammary gland epithelium. Decreased ABCA3 expression in breast cancer seems to be associated with poor prognosis.
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MESH Headings
- ATP Binding Cassette Transporter 1
- ATP-Binding Cassette Transporters/metabolism
- Biomarkers, Tumor/metabolism
- Blotting, Western
- Breast/metabolism
- Breast/pathology
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/secondary
- Female
- Humans
- Immunoenzyme Techniques
- Middle Aged
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Survival Rate
- Tissue Array Analysis
- Tumor Cells, Cultured
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Affiliation(s)
- S Schimanski
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital of Regensburg, Germany
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Koller M, Neugebauer EAM, Augustin M, Büssing A, Farin E, Klinkhammer-Schalke M, Lorenz W, Münch K, Petersen-Ewert C, Steinbüchel NV, Wieseler B. Die Erfassung von Lebensqualität in der Versorgungsforschung – konzeptuelle, methodische und strukturelle Voraussetzungen. Gesundheitswesen 2009; 71:864-72. [DOI: 10.1055/s-0029-1239516] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Görse R, Fischer K, Horn F, Klinkhammer-Schalke M, Hofstädter F, Ortmann O. Adjuvante endokrine Therapie bei postmenopausalen Patientinnen mit primärem Mammakarzinom im Tumorzentrum Regensburg. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Görse R, Kayser K, Fischer K, Horn F, Klinkhammer-Schalke M, Hofstädter F, Ortmann O. Lymphonodektomieraten in der operativen Therapie von Patientinnen mit Ovarialkarzinom im Tumorzentrum Regensburg. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Görse R, Kayser K, Fischer K, Pauer A, Klinkhammer-Schalke M, Hofstädter F, Ortmann O. Versorgungsqualität der Rezidivsituation bei Patientinnen mit Ovarialkarzinom im Tumorzentrum Regensburg. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Seasonal distribution of birth rates was only recently described in patients with high-grade gliomas. We analyzed 501 cases from the database of a Regional Cancer Center in Bavaria to assess annual periodicity in the birth dates of glioma patients. Prior to analysis, the number of births per month was normalized [number of births x 100,000/total number of births in Germany] to obtain birth rates per month. The approximation of the time series data by a one-year cosine model found that the glioblastoma birth rate exhibits a statistically significant annual variation, with the peak rate in January. Vitamin intake, infections, and other as-yet-unknown factors and exposures during pre- and perinatal early life may contribute to the seasonality of birth rate in patients with brain tumors.
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Affiliation(s)
- H J Koch
- Department of Neurology, University of Regensburg, Universitätsstrasse 84, 93053 Regensburg, Germany
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Meyer M, Opitz T, Caselmann WH, Schenkirsch G, Maisel T, Petsch S, Engel J, Schubert-Fritschle G, Klinkhammer-Schalke M, Mäder U, Göbel-Lissowsky M, Hölzel D. [Ten years of epidemiological cancer registration in Bavaria]. Gesundheitswesen 2009; 71:293-8. [PMID: 19326333 DOI: 10.1055/s-0029-1192032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
For a large territorial state like Bavaria only a decentralised cancer registration structure promises successful results: in the form of regional clinical cancer registries and--using the clinical registration as a base--one population-based registry. After ten years of epidemiological cancer registration in Bavaria it can now be shown that the chosen registration concept has proved itself. Currently the completeness of cancer notifications exceeded the international recommended threshold of 90%. A largely complete data stock is available for the years of diagnosis from 2004 to 2005. The task sharing between clinical and population-based cancer registries avoids double registration of data. Both types of registries are supporting physicians and hospitals with a wide palette of services. Together they enable transparency of cancer occurrence as well as transparency of health care for tumour patients.
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Affiliation(s)
- M Meyer
- Registerstelle des Bevölkerungsbezogenen Krebsregisters Bayern, Erlangen.
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Steinger B, Ehret C, Koller M, Lorenz W, Hofstädter F, Klinkhammer-Schalke M. Diagnostik und Therapie krankheitsbezogener Lebensqualität bei Brustkrebspatientinnen. Eine randomisierte klinische Studie. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Görse R, Kayser K, Ortmann O, Klinkhammer-Schalke M, Hofstädter F, Gerstenhauer M. Adjuvante endokrine Therapie von Patientinnen mit primärem Mammakarzinom im Tumorzentrum Regensburg. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Kayser K, Görse R, Ortmann O, Klinkhammer-Schalke M, Hofstädter F, Pauer A. Versorgungsqualität der Primärtherapie von Patientinnen mit Ovarialkarzinom im Tumorzentrum Regensburg. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Klinkhammer-Schalke M, Koller M, Ehret C, Steinger B, Ernst B, Wyatt JC, Hofstädter F, Lorenz W. Implementing a system of quality-of-life diagnosis and therapy for breast cancer patients: results of an exploratory trial as a prerequisite for a subsequent RCT. Br J Cancer 2008; 99:415-22. [PMID: 18665187 PMCID: PMC2527812 DOI: 10.1038/sj.bjc.6604505] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A system for quality-of-life diagnosis and therapy (QoL system) was implemented for breast cancer patients. The system fulfilled the criteria for complex interventions (Medical Research Council). Following theory and modeling, this study contains the exploratory trial as a next step before the randomised clinical trial (RCT) answering three questions: (1) Are there differences between implementation sample and general population? (2) Which amount and type of disagreement exist between patient and coordinating practitioners (CPs) in assessed global QoL? (3) Are there empirical reasons for a cutoff of 50 points discriminating between healthy and diseased QoL? Implementation was successful: 74% of CPs worked along the care pathway. However, CPs showed preferences for selecting patients with lower age and UICC prognostic staging. Patients and CPs disagreed considerably in values of global QoL, despite education in QoL assessment by outreach visits, opinion leaders and CME: Zero values of QoL were only expressed by patients. Finally, the cutoff of 50 points was supported by the relationship between QoL in single items and global QoL: no patients with values above 50 dropped global QoL below 50, but values below 50 and especially at 0 points in single items, induced a dramatic fall of global QoL down to below 50. The exploratory trial was important for defining the complex intervention in the definitive RCT: control for age and prognostic stage grading, support for a QoL unit combining patient's and CP's assessment of QoL and support for the 50-point cutoff criterion between healthy and diseased QoL.
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Klinkhammer-Schalke M, Ehret C, Koller M, Steinger B, Ernst B, Hofstädter F, Lorenz W. Diagnosis and therapy of illness-related quality of life in breast cancer patients. Results of a randomized clinical trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Görse R, Kayser K, Sturm K, Klinkhammer-Schalke M, Hofstädter F, Ortmann O. Operative Therapie des Mammakarzinoms im Tumorzentrum Regensburg 1998–2005. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1079209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kayser K, Görse R, Klinkhammer-Schalke M, Hofstädter F, Ortmann O. Stadienabhängige Lymphonodektomieraten in der Primärtherapie des Ovarialkarzinoms im Einzugsgebiet des Tumorzentrums Regensburg. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1079143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kayser K, Görse R, Popp N, Klinkhammer-Schalke M, Hofstädter F, Ortmann O. Analyse der Versorgungsqualität von Patientinnen mit Ovarialkarzinom im Tumorzentrum Regensburg. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Steinger B, Lorenz W, Koller M, Ehret C, Ernst B, Hofstädter F, Klinkhammer-Schalke M. Klinisch-relevante Lebensqualitätsdefizite als eigenständiger Teil einer neuen Konzeption von Krankheit bei Patientinnen mit Mammakarzinom. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Klinkhammer-Schalke M, Koller M, Ehret C, Steinger B, Ernst B, Hofstädter F, Lorenz W. Necessity for including quality of life diagnostics and therapy in routine oncological care: Evaluation by methods of clinical guideline implementation. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18594 Background: Application of quality of life assessment has become an important topic in oncology. Current approaches, however, have focused on technical issues within single center settings overlooking the requirements of routine care. We report on implementing of structural elements of a quality of life diagnostics and therapy system (QoL system). It was designed as integral part of the health care program for breast cancer patients in a regional tumor center. Methods: The QoL system was implemented by a systematic approach (Med. Care, 39, Suppl.2, 2(2001). Its elements comprised (a) coordinating practitioners (CPs) who functioned as gate keepers for QoL related therapies, (b) experts in the QoL unit who provided QoL reports and specific therapeutic recommendations based on patients’ responses to the EORTC questionnaire, (c) professional health care providers in psychotherapy, pain therapy, social support, physiotherapy/lymph drainage, and fitness (nutrition, sports), (d) clinicians (gynecologists) for patient recruitment and (e) opinion leaders for educational influence on the CPs to keep the QoL system in daily practice. Success of implementation (as indicated by CPs’ QoL-related changes in knowledge, attitude and behavior) was evaluated in a prospective study with breast cancer patients. Results: The QoL system was applicable in all of 170 patients recruited between Dec. 2002-June 2004 (age 34–86yrs, UICC 0–4, breast conserving surgery 67%). From 75 CPs (mostly gynecologists) in the area only 39 fulfilled criteria for the QoL system, 1 refused to participate. 38 CPs showed knowledge about QoL following educational outreach visits. Concerning attitudes and behavior, 64% of CPs found the experts’ reports comprehensible, 56% followed their recommendations, 20% made additional actions. Follow-up 4 months after first QoL measurement revealed improvements in pain, body image and social life (p < .05). Conclusion: The study—in combining doctor’s approach and patient’s demands—showed success using methods of guideline implementation by improving QoL deficits within a routine oncological care. Effectiveness will be analyzed in an ongoing randomized trial. No significant financial relationships to disclose.
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Affiliation(s)
| | - M. Koller
- Tumor Center Regensburg, Regensburg, Germany
| | - C. Ehret
- Tumor Center Regensburg, Regensburg, Germany
| | - B. Steinger
- Tumor Center Regensburg, Regensburg, Germany
| | - B. Ernst
- Tumor Center Regensburg, Regensburg, Germany
| | | | - W. Lorenz
- Tumor Center Regensburg, Regensburg, Germany
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Bauer R, Wild PJ, Meyer S, Bataille F, Pauer A, Klinkhammer-Schalke M, Hofstaedter F, Bosserhoff AK. Prognostic relevance of P-cadherin expression in melanocytic skin tumours analysed by high-throughput tissue microarrays. J Clin Pathol 2006; 59:699-705. [PMID: 16565225 PMCID: PMC1860409 DOI: 10.1136/jcp.2005.034538] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM To investigate whether protein expression or cellular localisation of P-cadherin is associated with clinicopathological characteristics in benign and malignant melanocytic skin tumours. EXPERIMENTAL DESIGN P-cadherin expression and the Ki-67 labelling index were analysed immunohistochemically by using tissue microarrays (TMAs). Membranous and cytoplasmic expression was scored semiquantitatively (0 to 2+). RESULTS P-cadherin protein expression of any intensity (1+ to 2+) was detected in the membrane in 41.5% (132/318) and in the cytoplasm in 64.2% (204/318) of patients. In general, P-cadherin expression was significantly reduced in malignant melanomas (p<0.001) and melanoma metastases (p<0.001), compared with benign nevi. Additionally, loss of membranous P-cadherin was associated with Clark level (p = 0.011) and tumour thickness (p<0.001). Interestingly, a significantly lower P-cadherin expression was shown by dermal nevi than by compound and junctional nevi (p = 0.005; p = 0.025). In primary melanomas, a Ki-67 labelling index <5% was not associated with P-cadherin protein expression, suggesting that loss of P-cadherin expression was not associated with proliferation. None of the other clinical and histological factors analysed was significantly related to P-cadherin expression. Low cytoplasmic P-cadherin expression was associated with tumour recurrence (p = 0.03) in all the patients who were analysed. After testing various multivariate Cox regression models, loss of cytoplasmic P-cadherin expression remained a highly significant adverse risk factor for tumour recurrence in patients with tumours <2 mm. CONCLUSIONS Loss of cytoplasmic P-cadherin expression is common in advanced melanomas and can be a prognostic marker of progression in patients with melanoma, most useful in patients with primary tumours <2 mm in thickness.
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Affiliation(s)
- R Bauer
- Institute of Pathology, University of Regensburg, Germany
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Lorenz W, Koller M, Ehret C, Klinkhammer-Schalke M. [Diagnosis and clinical decision making: a conceptional framework for predictive pathology]. Verh Dtsch Ges Pathol 2006; 90:25-30. [PMID: 17867576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In the clinical pathway of diagnosis and therapy of diseases two decisions are distinguished: diagnostic and therapeutic decision. The former is analysed by decision tables, the latter by decision trees. In both decisions pathology plays a dominant role, especially as a gold standard that is a test to which most people have developed trust. This definition is remarkably soft. An efficient diagnostic prediction depends on a high prevalence of the disease. This is frequently forgotten when tests have a high sensitivity and specificity. The mathematical concept behind this observation is the Bayesian theorem. This is highly important for predictive pathology because it allows to combine attributes with high likelihood ratio simply by multiplication and has been shown to be remarkably stable, e. g. in the differential diagnosis of acute abdominal pain. Pathology should take the leadership in prediction since it has a considerable power as the gold standard of many tests. However, a network is advisable with other basic disciplines.
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Affiliation(s)
- W Lorenz
- Tumorzentrum, Universität Regensburg
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Koch HJ, Klinkhammer-Schalke M, Bogdahn U, Hau P. Circannual distribution of glioblastoma and anaplastic astrocytoma diagnoses in men and women. BIOL RHYTHM RES 2005. [DOI: 10.1080/09291010500224066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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